Natural History of Macular Subretinal Hemorrhage in Age-Related Macular Degeneration

Abstract

Purpose: To define the natural course of extensive submacular hemorrhage in age-related macular degeneration (AMD). Patients and Methods: The clinical charts of 54 patients (60 eyes) older than 55 years with subretinal hemorrhage larger than 1 disk diameter and extending beneath the fovea were retrospectively reviewed. The age of the patient, the use of antihypertensive or anticoagulant medication, visual acuity, biomicroscopic and fluorescein and indocyanine green (in 33 cases) angiographic data were recorded at presentation and during follow-up. Results: At the initial examination, average visual acuity was 20/240 (range from 20/70 to light perception). During follow-up (mean 24 months) visual acuity worsened in 80% of the eyes with a mean final visual acuity of 20/1,250 (range from 20/100 to light perception). The initial size and thickness of hemorrhage were correlated with initial and final visual acuity. Recurrence of hemorrhage resulted in an important impact on final visual acuity. Anatomic outcome showed fibrous tissue proliferation in 23 eyes (38.3%), atrophic scar in 15 eyes (25%) and occurrence of a retinal pigment epithelium tear in 13 eyes (21.6%). Conclusion: The visual outcome in eyes with submacular hemorrhages due to AMD is very poor. Size and thickness of the hemorrhage influenced negatively the natural prognosis. A surgical approach can be considered although it has not yet a widespread use.

Vitrectomy with subretinal tissue plasminogen activator and ranibizumab for submacular haemorrhages secondary to age-related macular degeneration: retrospective case series of 45 consecutive cases

“…13 In addition, it is not yet clear what risk factors at presentation may affect final outcome. It is likely that the size, and thickness, of the haemorrhage will affect the probability of visual recovery; 14 however, the thickness of the haemorrhage may be difficult to measure accurately with optical coherence tomography (OCT), as a dense haemorrhage may obscure the signal from the retinal pigment epithelium. The haemorrhage area may be a more reproducible measurement that could help to identify the eyes that are most likely to benefit from treatment.…”

Early treatment of acute submacular haemorrhage secondary to wet AMD using intravitreal tissue plasminogen activator, C3F8, and an anti-VEGF agent

“…The natural history of this condition is severe, with few patients showing much improvement in visual acuity. 1,2 Accumulation of blood in the subretinal space has been shown in experimental models to cause photoreceptor damage within 24 h, 3 and this may be because of shearing of photoreceptor outer segments, impaired transport of nutrients, and direct iron toxicity derived from haemoglobin. [2][3][4] Therefore, timely intervention is required.…”

Effects of intravitreal gas with or without tissue plasminogen activator on submacular haemorrhage in age-related macular degeneration

“…[1][2][3][4] Shearing of photoreceptors by a fibrin clot, physical separation of photoreceptors from the retinal pigment epithelium, iron toxicity, and blockage of nutrient diffusion have been proposed as explanations for the retinal damage caused by thick subretinal blood. 5,6 The potential for vision loss has prompted investigation of safe and effective methods for removing thick blood beneath the macula, to speed visual recovery, and prevent irreversible blood-induced damage to the retina.…”